更为强化心肺代谢等整体功能的心肺运动试验新9图图解

The new 9 panels display of data from cardiopulmonary exercise test,emphasizing holistic integrative multi-systemic functions

目的：自1987年Wasserman教授开始用3行×3列9图展示心肺运动试验（CPET）数据以来,虽几经修改和添加,仍有不少重要指标尚未图示。新9图拟显示更多指标数据。方法：正常志愿者和患者首先完成静息状态肺功能检查、症状限制性最大极限CPET,连续测定12导联心电图、无创袖带血压、氧饱和度,以100 Hz测定气流并采集气样连续作氧气和二氧化碳测定并计算得出每次呼吸的数据,经每秒数据分切技术处理后再计算各指标的10 s和30 s平均值进行图示。结果：新9图中的第①~⑦图均以时间为＂X＂轴,分别以摄氧量、二氧化碳排出量、功率、心率、收缩压、舒张压、心率收缩压乘积、分钟通气量,呼吸交换比、二氧化碳通气效率、摄氧通气效率、氧脉搏、V5导联ST段水平和V5导联ST段斜率、潮气量、呼吸频率、呼气末氧分压、呼气末二氧化碳分压和血氧饱和度18个指标,以及动脉氧分压、动脉氧饱和度和动脉二氧化碳分压3个血气指标为＂Y＂轴。各图均有3条纵行虚线,自左至右依次代表静息、热身、功率递增运动和恢复期的分割线。此外,第①、③图中水平虚线分别代表最大摄氧量预计值（红色）、摄氧通气效率平台预计值（红色）和二氧化碳通气效率最低值的预计值（蓝色）。第⑧图以心率和二氧化碳排出量（Y）对摄氧量（X）作图,＂＋＂表示摄氧量和心率最大预计值的交点。第⑨图以潮气量（Y）对每分通气量（X）作图,纵行虚线为实测最大通气量,2条水平虚线分别为深吸气量和肺活量。结论：新9图可显示更多循环、呼吸、代谢等功能指标,特别是更突出展示循环相关功能指标,更有利于CPET的临床应用和健康管理。

Objective： Since 1987, professor Wasserman displayed cardiopulmonary exercise test starting （CPET） data as 3 rows and 3 columns 9 panels plots. Although many changes and additions, there still are some important functional parameters were not shown in 9 panels. We want to display more. Methods： The 100 Hz sampling data of symptom-limited maximal limit CPET was used to calculate breath-by-breath data after per second cutting technique, and then to calculate the average value of 10 s data for graphic display. Results： In new 9 plots, panels ① - ⑦ use time for the ＂X＂ axis, oxygen uptake, carbon dioxide elimination, loaded power, heart rate, systolic blood pressure, diastolic blood pressure, heart rate pressure product, minute ventilation, respiratory exchange ratio, CO2 elimination ventilatory efficiency, oxygen uptake ventilatory efficiency, oxygen pulse, ST segment level and ST segment slope at V5 lead, tidal volume, respiratory rate, end tidal oxygen partial pressure, end tidal carbon dioxide partial pressure and ox- ygen saturation of 18 noninvasive parameters, and arterial oxygen partial pressure, arterial oxygen saturation, arterial partial pressure of carbon dioxide 3 blood gas parameters for the ＂Y＂ axis respectively. There are 3 vertical dashed lines represent dividing lines of the resting, warm-up, incremental power loading exercise and recovery period respective- ly. In addition, panels ① and ④ have the horizontal dashed line represents the maximal oxygen uptake （red）, oxygen uptake efficiency plateau （red） and the lowest value of carbon dioxide elimation ventilatory efficiency （blue） expected value respectively. Panel ~ used heart rate and carbon dioxide elimination （as Y） against to oxygen uptake （as X）; the ＂＋＂ indicates intersection of the predicted maximum values of oxygen uptake and heart rate. Panel ⑨ used tidal volume （as Y） against over minute ventilation （as X）, vertical dashed line is the measured maximum ventilatory volume, the horizontal dashed lines were the inspiratory capacity and vital capacity respectively. Conclusion： New CPET 9 plots emphasizes on the integration of all circulatory, respiratory and metabolic etc functional parameters in human, and is conductive to optimization of clinical medical service and health management.